Nuts and Bolts of e-Prescribing: The Tools You Need to Get Started

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Now that you’re well-versed in the world of e-Prescribing, let’s go one step further and prepare you for your own health care software’s e-Prescribing journey.

Here are some helpful tools to get you started.

Integration Tool Kit

The DoseSpot e-Prescribing Integration Tool Kit reviews everything you need to know about e-Prescribing integrations and what a partnership with DoseSpot e-Prescribing entails. Specifically, you will learn:

• DoseSpot’s e-Prescribing Integration Platforms: Integration JumpStart and Integration Plus+
• The markets we serve: Medical, Dental, and Digital Health
• Development features, functionality, and API
• Integration project cycles
• The benefits of partnering with DoseSpot

Get your copy here.

How to Prepare Guide

With more than 150 e-Prescribing integrations under our belt, we know a thing or two about what an e-Prescribing integration requires. In our How to Prepare Guide, we take the guesswork out by providing you with the following information:

• Specific patient demographic requirements
• Character limits and field requirements
• How to correctly transmit patient demographic information from your health care software to DoseSpot

Get your copy here.

Need more information? Feel free to schedule a meeting with us!

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

The 7 Benefits of e-Prescribing for the Dental Community

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The role of oral health and its contribution to the population’s overall health, as well as the nation’s bottom line, has been in frequent discussions lately. With advocated access to dental care by a number of entities, governments and foundations, patients now understand that visiting their dentist is much more than receiving that fresh, clean feeling. It’s improving their quality of life.

However, with the ever increasing numbers of dentists and patients, along with Dental Support Organizations (DSOs) gaining significant prominence in the industry, the practice of dentistry is becoming more and more competitive. Patients now have more options to choose from when selecting their dentist and several factors weigh on their decision.

To align with this market shift, what is one component that the dental community can implement with ease to enhance their competitive advantage and attract and retain more patients? Or better yet, increase patient satisfaction, efficiency, and revenue, while simultaneously decreasing risks for dentists?

The solution: e-Prescribing.

Electronic Prescribing, known in short as e-Prescribing, has become a pertinent technology within dental practices that addresses the above conflicting goals. By incorporating e-Prescribing into the dental workflow at the point of patient engagement, several inherent efficiencies are presented:

1. Medication History

During a patient and dentist encounter, e-Prescribing enables dentists to verify a patient’s medication history and view up to two years of prescribed medications. This level of transparency allows for smarter treatment decisions and recognition of a patient who may be “doctor shopping” for controlled substances.

2. Safety

From a safety perspective, any drug-allergy or drug-drug interactions are flagged instantaneously while the clinical judgement of the dentist is still maintained if he/she elects to prescribe the medication. Dental-specific information such as a medication’s particular dental use, effects on dental treatment, and effects on bleeding are all seamlessly provided at point of care as well.

3. Productivity

With e-Prescribing, the totality of time to write a prescription for the patient is reduced from the traditional manual paper method, resulting in more time for direct interaction with the patient. The intrinsic productivity of e-Prescribing and its resulting patient interaction time may lead to incremental revenue as the opportunity is presented to discuss other dental issues and procedures.

4. Quality

Assessing e-Prescribing from a quality perspective, patient outcomes are significantly more accurate, consistent with quality initiates practiced in industry. It is getting it right the first time. As healthcare in general shifts to more measured and predictable patient outcomes, e-Prescribing goes a long way in addressing this new dynamic as it assists in providing a full panoramic view of a patient’s health.

5. Risk Reduction

Another benefit of e-Prescribing is risk reduction, especially when it comes to prescribing controlled substances. When controlled substances are electronically prescribed, the patient cannot lose the prescription or alter the dispense quantity or the medication itself. The prescription will be sent directly to the pharmacy with no chance of intermediaries touching it. In turn, this also banishes the need for paper prescription pads, thus eliminating the risk and liability involved with stolen prescription pads.

6. Patient Satisfaction

Perhaps the most significant aspect of the e-Prescribing equation is the increase in patient satisfaction. The extra time spent on dropping off and waiting for a prescription to be filled at the pharmacy is essentially eliminated as e-Prescribing diminishes the middle man and creates a seamless transaction for the patient.

7. Profitability

Due to improved efficiencies and increased patient satisfaction with e-Prescribing, a snowball effect is created relative to rising revenue. Not only will an increase in patient volume and retention occur, but administrative duties for office staff will lessen. Thanks to the more cost-effective vehicle of e-Prescribing, there will be no staff time required to manage the ordering and stocking of costly paper prescription pads and tamper-proof printing paper for controlled substances.

Overall, e-Prescribing is one tool in the dentist’s arsenal to meet the challenges of practicing dentistry today, which will allow for a more patient-centric strategy to be implemented, resulting in happier patients and dentists!

Author: Mark H.

Sources: Science Direct; Deming; Surescripts

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

e-Prescribing 101, Part III: End Users

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As we discussed in our previous post, e-Prescribing is the electronic transmission of a prescription from the prescriber’s device to the patient’s pharmacy of choice, therefore replacing the traditional paper prescription.

How does e-Prescribing work for end users?

While e-Prescribing software comes in many shapes and sizes, e-Prescribing integration is directly integrated into healthcare software such as an Electronic Health Record / Electronic Medical Record, telehealth application, or dental practice management solution. By way of integrating e-Prescribing into a healthcare software, the e-Prescribing platform becomes an integral component of a healthcare software’s product offering.

e-Prescribing integration seamlessly allows a prescriber to log into their existing healthcare software, select a patient, then search for, enter and send an e-Prescription for the patient in a few short steps. The process saves the prescriber time while improving patient outcomes.

What are the benefits of a custom, white labeled solution?

When an e-Prescribing solution is “white labeled”, this means the e-Prescribing user interface mirrors the look and feel of the healthcare software in which the e-Prescribing solution has been embedded. Colors, fonts, font sizes, layout – you name it – can all be completely customized to provide a seamless experience for end users.

Furthermore, mobile optimization has become a major trend as more healthcare software solutions are operating in the cloud and prescribers are accessing applications from multiple devices and multiple locations. This is why it’s important that the e-Prescribing functionality performs well in different environments, but most importantly, on smaller screens.

Responsive design is critical in ensuring that any e-Prescribing solution is accessible on every device. It’s the best one size fits all solution as this type of design allows the webpage to expand and contract in order to perfectly fit within any screen in both the traditional office and mobile settings. Ultimately, responsive design cuts down on development time as the e-Prescribing user interface does not need to be adjusted manually for each type of device (i.e. mobile, tablet, laptop, or desktop).

What does it take to cross the finish line and go live?

To go live with e-Prescribing and be able to send prescriptions electronically, all healthcare software companies must go through a Surescriptsâ„¢ e-Prescribing integration review. Surescripts operates the largest health information network that connects the diverse and expansive community of care partners nationwide, including pharmacies, providers, benefit managers, and health information exchanges.

As part of this e-Prescribing integration review, healthcare software companies will have to successfully execute various test scenarios during a web meeting with Surescripts. Test scenarios will be provided for the following services:

• NewRx: Route new prescriptions to the patient’s pharmacy of choice
• Refills: Receive prescription renewal requests and submit responses between doctor and pharmacy
• Medication History: View aggregated medication history data from pharmacies and pharmacy benefit managers (PBMs) upon receipt of patient consent.
• Prescription Benefit: Surescripts’ Prescription Benefit service puts eligibility, benefits and formulary information at a prescriber’s fingertips at the time of prescribing. This enables prescribers to select medications that are on formulary and are covered by the patient’s drug benefit.
• Electronic Prescribing of Controlled Substances (EPCS): Product has achieved Surescripts EPCS certification and has provided third-party audit documentation as required by the DEA.

Upon completion, healthcare software companies will be listed on the Surescripts website.

Healthcare software companies also looking for the ability to Electronically Prescribe Controlled Substances (EPCS) will need to go through a similar testing process with an approved e-Prescribing of Controlled Substances auditor such as the Drummond Group Inc., one of the first DEA approved certification bodies for EPCS.

Learn about DoseSpot’s e-Prescribing integration process by downloading our latest Integration Tool Kit.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part I: The Basics

e-Prescribing 101, Part II: Controlled Substances

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

e-Prescribing 101, Part II: Controlled Substances

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To continue our e-Prescribing 101 blog series, we shine light on controlled substances. What they are, their relationship to e-Prescribing, as well as the correlation between prescription drugs and the current opioid epidemic.

What is a controlled substance?

A controlled substance is a drug or chemical, such as illicitly used drugs or prescription medications, that is regulated by a government based on the drug or chemical’s manufacture, possession, or use.

Why are certain drugs categorized as a controlled substance?

A drug is typically classified as “controlled” due to the potential detrimental effects on a person’s health and well-being. As a result, state and federal governments have seen fit to regulate such substances.

It’s for this reason that drugs, substances, and certain chemicals used to make drugs of this caliber are classified into five categories. The drug segregation is dependent upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.

What are the medication schedules for controlled substances?

Schedule I

• Drugs with no currently accepted medical use and hold a high potential for abuse.
• Examples: Heroin, Marijuana (Cannabis), LSD, and Ecstasy

Schedule II

• Includes drugs that are accepted for medical use, but have a high potential for abuse, with use potentially leading to severe psychological or physical dependence.
• Examples: Vicodin, OxyContin, Adderall, and Ritalin

Schedule III

• Drugs with a moderate to low potential for physical and psychological dependence, with less abuse potential than Schedule I or Schedule II drugs.
• Examples: anabolic steroids, testosterone, and Tylenol with codeine

Schedule IV

• Drugs within this category have a low potential for abuse and dependence.
• Examples: benzodiazepines (Xanax, Valium, Ativan), Tramadol, and Ambien

Schedule V

• The lowest schedule for controlled substances, these drugs have lower potential for abuse and consist of preparations containing limited quantities of certain narcotics.
• Examples: Robitussin AC, Lyrica, and Motofen

What is EPCS?

EPCS stands for the Electronic Prescribing of Controlled Substances and is a technology that has been put into place to help address the rising issue of prescription drug abuse in the United States.

Understanding two-factor authentication

This two-step process is part of EPCS and ensures that only an authorized prescriber can electronically sign and send controlled substance prescriptions to a pharmacy, thus increasing patient safety. The process includes the entry of something you have, such as a token generated one-time code, and something you know, like a password. There are various options for two-factor authentication including: fob tokens, mobile phone applications, smart cards, USB thumb drives, and fingerprint scanners.

What is an opioid?

Opioids are substances that act on the body’s opioid receptors to produce euphoric effects, better known as a “high”, and are most often used medically to treat moderate to severe pain that may not respond well to other pain medications.

Why are opioids so addictive?

Opioid drugs work by binding opioid receptors in the brain, spinal cord, and other areas of the body to reduce the sending of pain messages to the brain, thus simultaneously reducing the physical feelings of said pain. They create artificial endorphins, the body’s natural painkillers, which tap into the “reward” sector of someone’s brain. However, with chronic use, opioids eventually trick the brain into stopping the production of these endorphins naturally. In doing so, the tolerance level increases and a patient is left with taking more medication to achieve the same effect.

They are most dangerous when taken in certain ways to increase the “high”, such as crushing pills and then snorting or injecting the powder, or combining the pills with alcohol or drugs, especially benzodiazepines. While some patients do take them for their intended purpose, they can still risk dangerous adverse reactions by not taking them exactly as prescribed, i.e. they take more at one time, or combine them with other medications not checked by their doctor.

Unfortunately, the fear of the intense withdrawal symptoms is often the biggest culprit when it comes to patients remaining addicted and ultimately leads them to continue taking the medication even if they no longer want to.

The correlation between prescription opioids and the opioid epidemic

In 2012 alone, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. In comparison to ten, even five years ago, this number is dramatically increasing as time goes on and more and more opioid overdoses are being reported on a daily basis.

Physicians and dentists are collectively responsible for providing 81.6% of opioid prescriptions in the United States and because of this, they have a very unique role in mitigating the impact of this opioid epidemic. Opioid addiction often starts at the hands of healthcare professionals simply trying to do their job, prescribing pain medications to relieve their patients of painful woes, especially during post-operative recovery.

While many prescriptions are meant for initial, short-term treatment, some doctors and dentists authorize refills time and time again because they want to help patients whom claim that they are still in pain. However, when the pill bottle and refills run out, patients are left seeking alternatives to create that euphoric escape they’ve become so accustomed to. This could mean an endless search of several different doctors to prescribe more substances (also known as doctor shopping), purchasing pills on the black market, or worse, turning to heroin as a cheaper and more readily available alternative.

Furthermore, the associated stigma often deters patients from receiving proper rehabilitation treatment and even if they do seek treatment, the government currently limits the number of patients a single provider may treat with drugs such as buprenorphine or methadone, which are both proven to reduce cravings and save lives. This leads to many patients relapsing.

How does e-Prescribing help?

• e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy.
• A patient will no longer have a paper prescription where the dispense quantity can be altered.
• Prescriber’s will have access to a patient’s medication history, therefore they can determine if a patient is doctor shopping or has a history of substance abuse.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part I: The Basics

e-Prescribing 101, Part III: End Users

Sources: DEA; DrugAbuse.gov; FDA

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

e-Prescribing 101, Part I: The Basics

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Another year has come and gone. Time to start fresh, gain new perspective, and bring it back to basics. e-Prescribing basics, that is.

During our reflection on 2016, the DoseSpot realized that there’s so much information out there regarding e-Prescribing and its different components; so many key opinion leaders and incredible resources to tap into to help educate the world about e-Prescribing. However, how could we make it easier? How can we assist those who just want to learn more about e-Prescribing in general without the endless Google searches?

That’s why we decided to create a three-part blog series covering all e-Prescribing basics; a one-stop-shop to answer all of your e-Prescribing questions and curiosities.

We can promise you this – this is one New Year’s resolution we won’t give up on.

Let’s get started.

What is e-Prescribing?

The term e-Prescribing has become a popular buzzword in the healthcare industry, but what exactly does it mean? To put it simply, electronic prescribing, known in short as e-Prescribing, is a method of prescription transaction that allows prescribers to write and send prescriptions to pharmacies electronically instead of writing, phoning-in, or faxing. It ultimately replaces the costly paper prescription pad and tamper-proof printing paper from a prescriber’s office for good.

e-Prescribing solutions have the following capabilities:

• NewRx: Route new prescriptions to the patient’s pharmacy of choice.
• Refills: Receive prescription renewal requests and submit responses between doctor and pharmacy.
• Medication History: View aggregated medication history data from pharmacies and pharmacy benefit managers (PBMs) upon receipt of patient consent.
• Prescription Benefit: Surescripts’ Prescription Benefit service puts eligibility, benefits and formulary information at a prescriber’s fingertips at the time of prescribing. This enables prescribers to select medications that are on formulary and are covered by the patient’s drug benefit.
• Electronic Prescribing of Controlled Substances (EPCS): Product has achieved Surescripts EPCS certification and has provided third-party audit documentation as required by the DEA.

What are the benefits?

e-Prescribing is not just the ability to send prescriptions electronically to pharmacies. It can also increase care quality in a number of ways:

• Eliminates the time and effort of trying to understand the prescriber’s handwriting, as well as the chance of an error in that translation.
• Makes sure that the prescriber is providing enough specific information for the pharmacist to fill the prescription, including the name of the drug, the dosage, its physical form, the route, and the prescriber’s instructions.
• Ensures that any drug-drug and drug-allergy interactions based on a patient’s medication history are found and reported to the prescriber before the prescription order is completed.
• Checks a patient’s pharmacy benefit and associated formulary at point of care to encourage the prescriber to choose the best medication option, both medically and financially.
• Increases patient medication pick-up adherence. Between 28% and 31% of all paper prescriptions either never make it to the pharmacy, or are not picked up once patients see how much it will cost.
• Drives down healthcare costs and improves patient satisfaction by getting medications to patients in a timely, convenient, and secure manner at the patient’s pharmacy of choice.
• Curbs prescription drug abuse and increases patient safety. No longer will a patient have access to a paper prescription, therefore no more altered dispense quantities, stolen prescription pads, or lost or duplicate prescriptions.
• Lowers costs associated with purchasing expensive paper prescription pads and the time and resources spent on redundant administrative tasks.
• Simplifies clinical workflows and allows prescribers to do what they do best and spend more time with their patients.

Who can e-Prescribe?

State or provincial legislation governs who can write a prescription, and under these rulings, any licensed physician, dentist, nurse practitioner, etc. allowed to write prescriptions by hand can also prescribe electronically.

Many electronic prescribing vendors also allow the use of proxy users, such as nurses, medical assistants, or office staff. While they cannot legally send a prescription to a pharmacy, they are able to access the e-Prescribing solution and fill in all required fields of the prescription for a prescriber to then approve and send.

What pharmacies allow e-Prescribing?

All 50 states and D.C. allow the e-Prescribing of both controlled and non-controlled substances and more than 90% of pharmacies can receive e-Prescriptions. Of course this includes the larger retail pharmacy chains such as CVS and Walgreens and mail-order pharmacies like Catamaran and Express Scripts.

Don’t miss the other parts of our e-Prescribing 101 series:

e-Prescribing 101, Part II: Controlled Substances

e-Prescribing 101, Part III: End Users

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

e-Prescribing of Controlled Substances – How Does Your State Measure Up?

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Navigating the waters of e-Prescribing can seem like a very daunting task considering the various state and federal regulations. To assist you in understanding, let’s review the information relative to e-Prescribing of Controlled Substances (EPCS) in all 50 states and how your state is measuring up.

Until recently, one-half of all U.S. States prohibited e-Prescribing of controlled substances. The thought was that paper prescriptions were safer and more secure. On September 15, 2015, however, Vermont became the last state to allow electronic prescribing of controlled substances, or Schedule II-V medications, making this process legal in all 50 U.S. states.

“We certainly believe that because of the enhanced security associated with e-Prescribing of controlled substances, the opportunity for abuse, misuse, and fraudulent activity is going to be dramatically reduced,” said Ken Whittemore, BSPharm, MBA, Senior Vice President of Professional and Regulatory Affairs at Surescriptsâ„¢, a nationwide health information network.

With this process now legal in all 50 states, and the safer option at that, it may be surprising to find that as of the most recent data available, only 7% of prescribers are sending controlled substances on the Surescripts network.

So, why the discrepancy? Are pharmacies not accepting electronic prescriptions? Are prescribers not able, or willing, to send these prescriptions electronically? Is this process too difficult? Why is this process used in some states so heavily, but so infrequently in others?

Pharmacies are ready!

In 2010, the DEA published a final ruling giving not only practitioners the option to write controlled substances electronically, but also for pharmacies to receive, dispense, and archive electronic prescriptions.

“It became incumbent upon a number of stakeholder groups in the pharmacy industry to tackle the issue and bring states into alignment with the DEA’s rule,” Ken Whittemore, BSPharm, MBA told Pharmacy Today.

Many pharmacy stakeholder groups, including APhA, the National Alliance of State Pharmacy Associations (NASPA), the National Association of Chain Drug Stores, and Surescripts, worked together over a 5-year period to rework some state laws, a process that can take a long time. Between 2010 and 2015, the pharmacy end of the spectrum worked hard on adoption and enablement, while prescriber enablement trailed. Using data from Surescripts, a study published in the January 2015 American Journal of Managed Care found that pharmacies with technology in place to accept e-Prescriptions for controlled substances increased from 13% in 2012 to 30% in 2013. By contrast, only 1% of all prescribers were capable of e-Prescribing controlled substances in 2013.

However, between 2012 and 2013, the number of e-Prescriptions for controlled substances grew dramatically from 1,535 to 52,423. Talk about a rapid jump!

According to the 2015 Surescripts National Progress Report, an average of 81% of pharmacies were enabled for EPCS in 2015. States including Hawaii and Mississippi were at the bottom of this list with less than 70% of pharmacies enabled, while states in the Northeast such as Massachusetts, New York, New Hampshire, and Rhode Island led this list with over 90% of pharmacies enabled for EPCS.

As of December 1, 2016, these numbers have only risen, with both Hawaii and Mississippi now having over 75% of pharmacies enabled. New York and Maine lead the race on that front with 96.8% and 95.2% of pharmacies enabled currently. This is in large part due to the state mandates put into place in 2016 and 2017, respectfully.

How about the prescribers?

With so many pharmacies enabled for EPCS, and legislature allowing this process in all 50 states, it may be surprising to know that an average of 3.39% of prescribers were enabled to e-Prescribe controlled substances according to the 2015 Surescripts National Progress Report.

Lengthy and time-consuming software auditing and prescriber identity proofing processes are likely factors that have stalled prescriber adoption of EPCS, but for pharmacists, the initial setup is much easier. In addition, there have not been enough incentive for prescribers to adopt EPCS.

e-Prescribing was a requirement under the federal Meaningful Use Electronic Health Record (EHR) program, which incentivizes the use of EHRs through financial payments. However, e-Prescribing of controlled substances was specifically exempted from Meaningful Use Stages 1, 2, and 3. For these reasons, it isn’t surprising that in 2015 the state with the highest number of prescribers enabled was New York, as that was one of the only states with an e-Prescribing state mandate in effect at that time.

In 2015, New York had 26.6% of their prescribers enabled for EPCS, with Nebraska not far behind at 15%. Fast forward to December 1, 2016 and prescriber enablement has grown tremendously in some states, but remain dismally low in others. New York now has 71.5% of prescribers enabled, with no other state having even one-third of their prescribers enabled for EPCS. In fact, the average percentage for EPCS enabled prescribers remains even as of December 1, 2016, at only 8.4% despite all of the benefits of EPCS.

Why are these numbers so varied?

Electronic prescribing of controlled substances (EPCS) reduces fraud and keeps patients from getting multiple prescriptions for the same drug, so why are some states seeing major buy-in while other states are lagging? Much of this is impacted by states that have legislation in place to either require or reinforce the use of e-Prescribing, as outlined below.

Minnesota

Minnesota was the first state to implement an e-Prescribing mandate in 2008 in order to improve quality outcomes and efficiency in health care. The state mandate required prescribers, pharmacists, pharmacies, and pharmacy benefit managers (PBMs) to be up and running with e-Prescribing by January 1, 2011, however, only 13% of prescribers are actually enabled for EPCS as of late. Could this be because legislation doesn’t enforce its own law or penalize prescribers for not adhering to this legislature? Marty LaVenture, director of the Minnesota Office of Health IT and e-Health, seems to agree and notes, “policy levers could be used to encourage full adoption and use of e-Prescribing capabilities.”

New York

As you may already know, New York was the first state to require e-Prescribing of all prescriptions, both controlled and non-controlled, and the first to implement penalties for failing to adhere to this ruling. Penalties include, but are not limited to, loss of license, civil penalties, and/or criminal charges. With the highest rate of prescriber EPCS enablement, it’s evident that New York prescribers are taking this quite seriously.

Maine

Maine is the next state to implement an e-Prescribing regulation as of July 1, 2017 where all opioids prescriptions must be sent electronically. With only 0.6% of prescribers enabled for EPCS in the state according to the Surescripts report, and up to 2.9% as of the beginning of December 2016, it’s clear that Maine has a long way to go for all prescribers to be ready to follow this regulation.

In Summary

Although it’s legal in all 50 states, and there are many reasons EPCS is safer than on paper or another method, there is still a great discrepancy between EPCS enabled pharmacies and EPCS enabled prescribers due in part to the strict requirements put in place on the prescribers. While the statistics referenced here show that provider adoption of EPCS is still low in comparison to the pharmacy adoption we have seen, it’s important to remember that the e-Prescribing of non-controlled substances also took years to reach the level we now see today. It seems the only tried and true way for these numbers to rise quickly and meet the numbers we currently see for pharmacy enablement is to implement regulations and penalties for not adhering to this requirement as outlined in the above state mandates. All eyes are now on Maine to see how their journey goes.

Check out the maps below to see how your state measures up!

Author: Lindsey W.

Sources: American Pharmacists Association; USA Today; Surescripts 2015 National Progress Report; Surescripts EPCS; Minnesota Department of Health; Maine Medical Association; e-Prescribing Blog; CMS

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management, and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing to more than 150 health care software companies since 2009. For more information, please visit www.DoseSpot.com.

Maine’s New Mandate and What It Means for Opioid Prescribers

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Maine is well known for its rocky coastline, iconic lighthouses, sandy beaches, and lobster shacks. However, past the classic scenery is where you’ll find the state dealing with a crisis that others across the United States are also experiencing: the opioid epidemic.

In 2015, Maine suffered an astounding 272 drug overdose deaths, following 208 deaths of the same cause in 2014. Sadly, there is no end in sight. Maine’s Attorney General Janet Mills declared that drug overdose deaths are up 50% in 2016, with the first 6 months of the year experiencing 189 drug overdose deaths alone. What’s worse, the number of overdose-related deaths in 2016 is expected to reach a new record, surpassing those numbers of 2014 and 2015.

“Heroin addiction is devastating our communities,” Maine Governor Paul LePage said in a statement. “For many, it all started with the overprescribing of opioid pain medication.”

As a state with the largest number of patients per capita on prescription for long-acting opioids, the news that prescribed pain medication is further fueling opioid addiction is unsettling.

This is why Maine has decided to take action.

Maine’s new statue, “An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program,” entails a number of rules and regulations designed to reduce the harm of over-prescribing opioids relative to the abuse and misuse of such substances. This bill, signed into law by Governor LePage, mandates a number of changes for doctors and dentists who prescribe controlled substances in Maine.

[Read: The Maine Mandate – Confronting Controlled Substances Head-On]

What changes will be implemented?

Dosing and Duration of Schedule II Medications

First, this law imposes limitations on the medication dosage, as well as the duration of a prescription, that can be prescribed to a patient. According to Gordon Smith, JD, Executive Vice President of Maine Medical Association (MMA), the original bill limited opioid prescriptions to three days for acute pain and fifteen days for chronic pain. However, this legislation will now mandate a limit of seven days for acute pain and thirty days for chronic pain on opioid prescriptions. This law goes in to effect January 1, 2017.

In terms of dosing, prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 100 Morphine Milligram Equivalents (MMEs) per day to new opioid patients (after July 29, 2016). Existing opioid patients with active prescriptions in excess of 100 MMEs per day are referred to as “Legacy Patients” and prescribers may not prescribe any combination of opioid medication in an aggregate amount of more than 300 MMEs per day from July 29, 2016 to July 1, 2017.

Prescription Monitoring Program

Maine prescribers are required to query the Prescription Monitoring Program (PMP) database prior to prescribing opiates. Although this requirement has been in place since 2005, surveys indicate that only 7-20% of Maine prescribers currently utilize the state’s PMP.

The purpose of checking this central state database is to identify patients who may be doctor shopping and minimize multiple controlled substance prescriptions for one patient. This aligns with the state’s hope of empowering healthcare providers to recognize potential substance abuse and treat patients accordingly.

PMP’s can also be most effective when linked with an e-Prescribing solution. Working together, e-Prescribing eliminates the need for paper prescriptions, thus reducing the risk of altered dispense quantities, stolen prescriptions or prescription pads, and the reselling of such prescriptions before they’re filled as a means of lessening the red flags if a patient is doctor shopping.

[Read: The Link Between PDMP’s and e-Prescribing]

Continuing Education

Via this statute, prescribers must complete three hours of continuing education every two years as a condition of prescribing opioid medications. This specific addiction training is only required if a prescriber wishes to continue prescribing opioids.

Electronic Prescribing

All opioid prescriptions must be sent electronically as of July 1, 2017.

What exceptions are part of this mandate?

The Maine Medical Association (MMA) confirms that exceptions from the law’s provisions may be granted for the following:

• Cancer Patients
• Hospice Care
• End-of-Life Care
• Palliative Care
• Patients on Medication-Assisted Therapy (MAT)
• Patients receiving medication in hospitals and nursing homes

The MMA is currently seeking an exception for burn victims as well.

Due to the supremacy clause of the U.S. Constitution, federal law takes priority over state law, therefore prescribers within the Department of Veterans Affairs (the VA) cannot be regulated by this type of legislation so long as the medication is dispensed at a VA pharmacy. Furthermore, dosage and duration limits would not apply to a prescription written for a veteran by a prescriber outside of the VA system if the prescription were filled in a VA pharmacy.

How does this bill measure up?

With this bill, Maine becomes the third state behind Minnesota and New York to require e-Prescribing and the second to require the electronic sending of a controlled substance after New York imposed a similar mandate in March of 2016. Since the implementation of New York’s mandate, total numbers of opioid analgesics prescribed fell by 78% within the first four months.

Important dates to remember:

Lastly, as part of the state’s strategy, Maine has launched Dose of Reality, a website to help educate and inform their citizens of the dangers of painkillers and where to turn for help.

Author: Lindsey W.

Sources: Maine Medical Association; Maine.gov; Medscape; WCSH6; Bangor Daily News

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Addressing Dentistry’s Role in the Opioid Epidemic

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Unfortunately, the opioid epidemic that is currently grappling the United States isn’t exactly news. Headlines appear on a daily basis in regards to this addiction, the overdoses and fatalities, as well as the healthcare community’s contribution to this crisis, both the good and the bad.

We’ve seen Congress, the Surgeon General, and many other organizations make extreme efforts to combat this crisis, yet despite the widespread media attention, many healthcare professionals still don’t realize how dangerous the drugs can be or how addictive they are.

DoseSpot recently conducted a live webinar in an effort to educate and discuss the critical role that dentists in particular play in mitigating the current opioid epidemic that is upon us and during that time, the following crucial points were made:

The blame game needs to stop

Blaming others only diverts the necessary action of collectively coming together as a nation, regardless of one’s associated industry. Healthcare, Law Enforcement, Politics – there needs to be a strong, unified foundation for which we can assemble and fight this battle together.

Break the habit: prescribing patterns of pain medication

Dentists serve a unique role in overcoming this epidemic due to the nature of their work and the procedures they perform, specifically wisdom teeth extraction. It’s a fair statement that the majority do not enter the healthcare industry with ill intent of harming their patients, yet it’s also fair to say that lack of proper education and prior pharmaceutical marketing tactics have fueled poor prescribing patterns. In order to change one’s behavior, programmed thoughts and approaches must be reevaluated.

Opioid addiction does not discriminate

This addiction can affect anyone regardless of one’s socioeconomic status or in some cases, a person’s relationship to their dentist. What DoseSpot coins as “The Insider Threat,” we reveal how certain folks pose a potential risk relative to obtaining controlled substances, both knowingly and secretively. Stories of addiction that are shared during our recent webinar further prove that opioids do not discriminate.

Solutions are available

The truth of the matter is, there is not one single solution that can work independently. It needs to be a collective effort and innovation is critical to success. There needs to be multifaceted solutions to tackle this complex problem ranging from increasing specialty training and education to proper treatment technology, data, and analytics.

To learn more on dentistry’s role in the opioid epidemic, watch the full webinar here.

Presenters:

Greg Waldstreicher, CEO, DoseSpot

Dr. John Zweig, Chief Dental Officer, Dental Associates

Donald Whamond, Chief Technology Officer, Dental Associates

Jason Wolan, Director of EHR Implementation, Great Expressions Dental Centers

Daniel Smelter, Director of Business Analysis, Benevis, Inc.

About DoseSpot

DoseSpot is a Surescripts certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

3 States Laying Down the Law on Opioids

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On par with our last post, the widespread media attention and devastating losses associated with our nation’s current opioid epidemic has sparked certain state legislatures to regulate and improve providers’ prescribing habits for prescription painkillers.

With good intentions in tow, some rulings seem to lack readily available solutions that are proven to curb this crisis. However, they do realize that their recent proposals do not mark the end of this uphill battle, rather multifaceted solutions need to be in place to truly, and successfully, overcome this epidemic.

[Read: Overdose Awareness – The Time to Stand Together is Now]

Here are three states that have recently proposed rulings on how opioids should be prescribed:

Vermont

Coined as a “cutting-edge” approach to overcoming the opioid crisis, Governor Peter Schumlin announced proposed limits on the number of opioid medications that could be prescribed.

Like every other state, Vermont has seen an incredible increase in deaths related to opioid and heroin overdose in recent years and Governor Schumlin is no longer sitting on the sidelines.

Earlier this year, he approached both the FDA and pharmaceutical industry in his State of the State address claiming that OxyContin “lit the match that ignited America’s opiate and heroin addiction crisis,” and that the booming American opiate industry knows no shame, an outcry after the FDA approved OxyContin for children a few months ago.

The proposed ruling states that the severity and duration of pain will determine the specific limit for a prescription of opioids. For example, a minor procedure with moderate pain would be limited to 9-12 opioid pills and the amount would increase based on the procedure performed and the level of pain a patient claims. The ruling would also require providers to discuss risks, provide an education sheet to the patient and receive an informed consent for all first-time opioid prescriptions.

The Green Mountain State’s Governor believes that limiting the number of opioid pills prescribed would be an effective way to reduce addiction, yet some folks believe the ruling would only encourage patients to seek illicit drugs elsewhere if they cannot receive pain medication through their provider.

This does make sense considering many former and current heroin abusers have stated that their addiction started from a prescription and when the pill bottle ran out, they were left seeking these drugs on the streets, which have proven to be very, if not more, dangerous than the prescription.

However, the intent of the Governor’s ruling is to prevent addiction from ever happening in the first place. His ruling is specific to cases of acute pain, therefore changing the over-prescribing habits and learned behavior of utilizing opioids as first-line therapy; habits that ensued in large part due to incentives, the surge of pharmaceutical marketing tactics and claims that painkillers were not addictive.

[Read: How Costly Are Prescription Pain Meds?]

New Jersey

With the rate of drug overdose deaths on the rise by 137% since 2000, New Jersey is another state to recently propose new regulations on how and to whom opioids are prescribed.

New Jersey, much like many other states, believes that prevention is key when fighting this crisis and they couldn’t be more correct. Unfortunately, several barriers often occur when seeking appropriate treatment after a patient becomes addicted, (for example, providers are limited to certain amounts for which they can administer reversal drugs), and therefore why not PREVENT addiction, rather than simply TREAT addiction when at many times, it’s too late?

Senator Raymond Lesniak has introduced a bill that would put restrictions on health insurance coverage for opioid medications, while also requiring prescribers to first consider alternative pain-management treatments, follow federal prescribing guidelines and explain the risk of addiction with such substances to their patients before prescribing. Furthermore, providers will need to complete several steps before receiving approval of an opioid prescription. These steps include providing a patient’s medical history, conducting a physical exam and developing an appropriate medical plan for treating a patient’s pain.

While new rulings in place can certainly shift this epidemic, Angela Valente, the executive director of the Partnership for a Drug-Free New Jersey, said it best:

“Awareness and education is the key factor in preventing the abuse of opiates—everyone must have a role in reversing this epidemic, including lawmakers, parents, coaches, educators, and yes, even doctors and dentists.” – Angela Valente

Dr. Andrew Kolodny, executive director of Physicians Responsible for Opioid Prescribing, further backs Valente’s point while also motioning that the medical community has been prescribing too aggressively.

[Read: The Opioid Epidemic: Are Dentists the Black Sheep?]

Pennsylvania

Unfortunately, Pennsylvania experienced 3,500 deaths last year as a result from drug overdose, one of the highest overdose rates in the nation.

The state has had a Prescription Drug Monitoring Program for quite a few years now, however it wasn’t functional until August 2016, when their new program was officially rolled out. Pennsylvania requires providers to query the state’s prescription drug database the first time they prescribe a controlled substance to a patient or if they have reason to believe that the patient is doctor shopping.

Governor Tom Wolf addressed other initiatives underway including requiring providers to query the database EACH time they prescribe opioids, updating medical school curriculum and continuing education, changes to the process of pain care to lower inappropriate use of opioids, and improved screening, referral and treatment for addiction.

What’s bothersome in Pennsylvania, is the method in which these substances have to be prescribed. The Pennsylvania Controlled Substance Act requires narcotic prescriptions to be handwritten on paper prescription pads, yet every other substance can be electronically prescribed. This allows the risk of written prescriptions being lost, stolen, or sold. Luckily, Senator Richard Alloway intends to introduce this measure before the legislative session’s end.

It’s promising to see how the above states are utilizing their state’s Prescription Drug Monitoring Program, or PDMP. All three require their prescribers to query the affiliated state database, however the parameters in which, or how often, they check varies.

While said efforts are better than no effort at all and states are starting to fully understand the need for multifaceted solutions in order to overcome this epidemic, one key solution is missing. E-Prescribing.

[Read: The Link Between PDMP’s and e-Prescribing]

How does e-Prescribing help combat this epidemic?

• e-Prescribing diminishes the possibilities of duplicate or lost prescriptions since the prescription is sent directly to the patient’s pharmacy
• A patient will no longer have a paper prescription where the dispense quantity can be altered
• Prescribers will have access to a patient’s medication history, therefore they can determine if a patient is “doctor shopping” or has a history of substance abuse

To learn how to incorporate e-Prescribing as a solution to the opioid epidemic, schedule a meeting with DoseSpot today.

Sources: NY Times; Boston.com; ABC News; Press of Atlantic City; PennLive

About DoseSpot

DoseSpot is a Surescriptsâ„¢ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.

Docity Meets Increasing Patient Demands with Innovative Telehealth Platform and Integration of DoseSpot e-Prescribing Solution

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NEEDHAM HEIGHTS, MA – Docity, a veteran-owned, connected telehealth platform that enables real time HIPAA-compliant communications between healthcare providers and patients, has announced their strategic, patient-driven integration of DoseSpot’s e-Prescribing solution.

The key component of Docity’s business model is simple: to put patients first by listening to their needs and adapting a digital healthcare system based on those needs.

“Docity’s business is driven solely by the patient-centric model and DoseSpot understood that crucial factor from the very beginning,” said James Cowan, CEO, Docity. “As part of this model, Docity knew that incorporating e-Prescribing was a non-negotiable. E-Prescribing isn’t just a feature; it’s something you must have in today’s competing market.”

Prior to integrating DoseSpot, Docity was offering their connected health platform to several clinics with existing patients, but prescribing was done on the clinician’s own terms. Since the integration with DoseSpot’s e-Prescribing solution, Docity will now be able to offer a comprehensive digital platform to serve the needs of individual patients on a subscription basis.

“The integration process with DoseSpot was a breeze,” Cowan added. “Their team was very flexible and actively engaged, working around the clock to ensure that Docity met al Surescripts certification requirements in a timely manner. Furthermore, they were able to work directly with our developers and their project management tool kept everyone organized which made for a seamless process overall.”

Docity is not only meeting the increasing demands of patients and providers, but the DoseSpot integration has better leveraged relationships with key stakeholders, primarily from a compliance perspective.

“Since integrating with DoseSpot, Docity has seen significant buy-in from highly sought after individuals, providers and companies in the healthcare community who are more eager than ever to stand behind our vision,” said Cowan. “It’s a win-win for both parties.”

“Our partnership with Docity is rooted in understanding and listening to both the patients’ and providers’ demands. Patient-centricity is a current healthcare trend we are committed to upholding as the healthcare landscape continues to evolve,” said Greg Waldstreicher, CEO, DoseSpot. “As a telehealth company, Docity recognized that e-Prescribing is a key component of the value-based delivery model and should be interwoven at the forefront to create a seamless healthcare experience for all involved.”

To learn more about how Docity is meeting the demands of the healthcare community with comprehensive and innovative solutions, please visit www.DoseSpot.com or contact Shauna Leighton, Shauna@DoseSpot.com.

About Docity

Docity Health is a connect health startup headquartered in Chattanooga, TN. Their mission is to connect providers with patients and patients with their health through on demand access to healthcare. For additional information please visit www.Docity.com.

About DoseSpot

DoseSpot is a Surescriptsâ„¢ certified e-Prescribing platform specifically designed to integrate with electronic health record, electronic dental record, practice management and telehealth software. DoseSpot is certified to e-Prescribe controlled substances and has provided simple, affordable and integratable e-Prescribing solutions to healthcare IT companies since 2009. For more information, please visit www.DoseSpot.com.